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CHAIN OF CUSTODY RECORD <br /> Advanced Date 6 � g —L of <br /> GeoEnvironmental, Inc Page <br /> ` 837 Shaw Road- Stockton, California- 95215- (209)467-1006 Fax (209) 467-1118 �~ <br /> Client Pro ect M nag r Tests Required <br /> 4 d on <br /> 7P one N mber <br /> Samplers (Signature) Invoice <br /> AGE <br /> Project Name �� S f �e � � a Client ❑ <br /> Sample Type No of /L <br /> Sample Location Date Time Water Solid Notes <br /> Number Description Comp Grab Air Conts <br /> eceive y rgnaturetel7fm <br /> Relinquish e y ignature) <br /> Dale(Ti <br /> Received b Si nature a <br /> Relinquished by (Signature) y ( 9 ) <br /> Relinquished by (Signatwe) Received by Mobile Laboratory for field analysts (Signature) DatelTtme <br /> Dispatched by (Signature) Date[Time Received for Laboratoryp- Date/Time <br /> Method of Shipment r L ratory Name <br /> e f <br /> I hereby authorize the performance of the above indicated work <br /> Special Instructions � <br /> ff/r <br /> IIIII,-IIIIIIIIIIIIII— <br /> R2) <br /> )'<S �S` <br />